ACL revision / meniscal allograft transplantation

"My left knee problems date back to 1995 when I ruptured my anterior cruciate ligament (ACL) playing football. Obviously surgery was far less advanced at the time and information was not as readily available given the internet was in fairly formative stages, so I was reliant on the information I was given and decided to have the repair done with a synthetic graft (carbon fibre / polyester mix) given that I was forecast to return to activity much quicker than with a patella tendon graft, which was the other option.

"Mr Attar is simply first class and the best surgeon I have ever come across"
Mr Adam Garner - treated June 2014

"Unfortunately the operation was never really successful and whilst it stabilized the knee I was unable to return to the level of football I had played previously. Over the next 18 or so years I had numerous cartilage problems and a further 10 operations to try and sort out the constant swelling in my knee. At this point I was unable to undertake any type of physical activity without significant swelling in my knee and was in almost constant pain.

"I felt I was reaching the end of the road and that I was resigned to a life of inactivity which at age 47 was something I was not really happy with. I saw that my only option was for a knee replacement at some future point but I was reluctant to go down this route.

"I decided that I need to do something and contacted my insurers BUPA to see if I could arrange a consultation with Mr Fahad Attar, consultant orthopaedic surgeon at Spire Cheshire Hospital.

"At my consultation I was highly impressed with Mr Attar – for the first time in many years I felt that was a possibility that I could regain some level of physical activity and be free from pain and swelling. Mr Attar initially undertook  a series of MRI scans and X-rays and then an arthroscopy of my knee and told me that there was very little left of my original ACL graft and that there was only third of my medial meniscus remaining following the various surgeries. He advised that if I did nothing then I was likely to require a knee replacement within 2-3 years but that he could put this off by 10-15 years by undertaking an ACL revision and a meniscal allograft.

"The operation was in 2 stages as follows:

1.            Removal of what was left of my original ACL graft which then involved plugging the tunnels from the original operation by way of bone graft.

2.            Six months later I had the new ACL graft inserted from my hamstring and at the same time the meniscal (donor) allograft. The allograft procedure was very new and required a suitably sized meniscus to be obtained from a tissue bank in the US and Mr Attar provided me with all the information relating to this and assured me it was fully sterile and there were no possibilities of cross contamination. The surgery was performed at Spire Cheshire hospital on 13th June and it was an extremely complex procedure. I was in a knee brace and on crutches for 9 weeks whilst the meniscus was healing and then began weight bearing and building the leg back up through exercise and physiotherapy.

"Mr Attar is simply first class and the best surgeon I have ever come across. He has an excellent manner which makes him approachable for information. Throughout all our discussions he took time to explain the procedures very clearly and what would be involved post-surgery. This meant that I was really well informed and let me investigate all aspects of the surgery through the internet so that I knew exactly what to expect.

"I am now four months post op and whilst there is still a long way to go before I can return to full functionality I do feel the knee is feeling better each day. I have no expectations or timescales to work to but I genuinely feel that I can return to a level of activity that I could previously only have dreamed of. I would recommend Mr Attar and this procedure 100%."

Mr Fahad Attar said:

"Meniscal transplant (replacement) surgery is a joint preservation surgical option in patients who have previously had their cartilages removed due to tears and have now got on going pain in the knee. Rather than waiting for the knee to totally wear out and develop arthritis when the patients would require a partial or total knee replacement, this procedure gives an option to get patients pain free, improve their function and at the same time protects their joint from further degeneration hence delaying any joint replacement procedures. Current evidence suggests that this can be successfully achieved for 10-12 years. Depending on the amount of cartilage previously removed, the options are using a biosynthetic scaffold which is NICE approved, or a total meniscal replacement using an allograft. There are only a few centres and few surgeons currently in the UK providing this surgery and service for suitable patients.

"Adam Garner’s case was complex, and he required an ACL reconstruction for giving him knee stability and also a meniscal transplant operation to try and preserve his joint which already had some arthritis changes. He has done well following his operative procedures and continues to improve in his pain and function and hopefully this procedure will buy him some time and delay the need for early joint replacement surgery."

For more information or to make an appointment with Mr Attar please call 01925 215029 or complete the enquiry form on the right hand side of this page.

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